Path 5,7

Question 1

If a trichrome stain of the liver is shown, and there is lots of blue, it is ___

Answer 1

Fibrosis

Question 2

Accumulation of fat within hepatocytes

Answer 2

Steatosis

Question 3

Mallory bodies are associated with ____

2. and are composed of ___

Answer 3

• Alcoholic and nonalcoholic steatohepatitis
• cholestatic conditions
• Wilson disease

2. Intracytoplasmic eosinophilic deposits of cytokeratin

Question 4

Necrosis vs. apoptosis

Answer 4

Necrosis has inflammatory response apoptosis does not

Question 5

Lymphoid follicles are common in hepatitis ___

Answer 5

C

Question 6

Visible bile in tissue sections suggests ___

Answer 6

Cholestasis

Question 7

In viral hepatitis, serum liver transaminases (ALT, AST) are ___

Answer 7

Markedly elevated early but will decrease as either the acute injury resolves or parenchyma is lost

Question 8

3 leading causes of chronic hepatitis, liver failure, and cirrhosis

Answer 8

Chronic hep B and C
Nonalcoholic fatty liver disease
Alcoholic fatty liver disease

Question 9

Chronic liver failure is most commonly associated with ___

Answer 9

Cirrhosis

*but not all cirrhosis leads to chronic liver failure

Question 10

4 major consequences to portal hypertension:

Answer 10

1. Ascites
2. Formation of portosystemic shunts (which causes hemorrhoids, esophageal varices, can lead to massive hemorrhage and death)
3. Congestive splenomegaly
4. Hepatic encephalopathy

Question 11

Flapping asterixis is a characteristic sign of ___

Answer 11

Hepatic encephalopathy

• hand flapping tremor that often accompanies metabolic disorders
• usually induced by extending the arm and dorsiflexing the wrist

Question 12

___ is now the most common cause of acute liver failure necessitating liver transplantation in the US

Answer 12

Acetaminophen

Question 13

Causes of liver failure

Answer 13

• A: acetaminophen, hep A, autoimmune hep
• B: hep B
• C: hep C, cryptogenic
• D: hep d, drugs/toxins
• E: hep E, esoteric causes (Wilson, Budd-Chiari)
• F: fatty change

Question 14

Viral hepatitis transmissions

Answer 14

A and E: fecal-oral
B and C: parenteral, sexual, perinatal
D: parenteral
E: water borne, monkeys, cats, pigs, dogs

Question 15

Which hepatitis is most commonly chronic?

Answer 15

C

Question 16

Acute vs chronic hepatitis viruses

Answer 16

A and E are AcutE only
Consonants are Chronic
*except E in IC and pregnant people

Question 17

___ is endemic in equatorial regions and frequently epidemic

Answer 17

Hep E

Question 18

Autoimmune hepatitis characteristics

Answer 18

• High serum titers of autoantibodies in 80% of cases
• viral serologic markers are negative
• young to middle-aged white females

Question 19

Forms of alcoholic liver disease

Answer 19

1. Hepatitic steatosis
2. Alcoholic hepatitis
3. Alcoholic cirrhosis

Question 20

Mallory bodies are found in ___

Answer 20

Alcoholic hepatitis

Question 21

Hereditary form of iron overload are

Answer 21

Hemochromatosis

Question 22

Iron overload secondary to transfusions, ineffective erythropoiesis, increased oral intake, chronic liver disease, etc.

Answer 22

Hemosiderosis

Question 23

Iron granules are ____ with H&E stain and ____ with Prussian Blue stain

Answer 23

Golden brown

Dark blue

Question 24

In Wilson disease, serum ceruloplasmin levels are ___

Answer 24

Low

• copper levels are no help
• hepatic copper quantitation, and urinary copper levels help dx as well
• genetic testing is available

Question 25

Clinical presentation of Wilson disease

Answer 25

``` Neuropsychiatric disturbances Parkinson-like tremors Clumsiness Difficulty speaking Kayser-Fleiscger rings (green to brown deposits of copper in the eye) ```

Question 26

1. Clinical features of alpha-1 antitrypsin deficiency? | 2. Labs?

Answer 26

1. Neonatal hep with jaundice in some cases, adolescents present with symptoms related to cirrhosis, hepatitis, or pulmonary disease, adults can develop hepatocellular carcinoma. Emphysema in some 2. Low levels of serum alpha 1 antitrypsin. PAS positive and diastase-resistant inclusions

Question 27

Obstruction of extrahepatic bile ducts No sex predilection No antibodies *Symptoms?

Answer 27

Secondary biliary cirrhosis *pruritis, jaundice, malaise, dark stools, hepatosplenomegaly

Question 28

Primary sclerosing cholangitis (PC) is commonly seen in association with ___

Answer 28

IBD, particularly chronic UC

Question 29

Middle aged women Autoimmune Antimitochondrial antibodies

Answer 29

Primary biliary cirrhosis

Question 30

Young males Immune-mediated injury No autoantibodies

Answer 30

Primary sclerosing cholangitis (PC)

Question 31

All of the reactive and neoplastic conditions covered in class arise from hepatocytes except ___

Answer 31

Cholangiocarcinomas , which arise from bile ducts

Question 32

Most common congenital anomaly of the pancreas

Answer 32

Pancreas divisum -failure of ducts to fuse

Question 33

Band like ring of normal life pancreatic tissue around the 2nd part of duodenum

Answer 33

annular pancreas

Question 34

M vs W Acute pancreatitis caused by: 1. Gallstones 2. Alcohol

Answer 34

I. F 3:1 | 2. M 6:1

Question 35

Saponification occurs in ___

Answer 35

Acute pancreatitis

Question 36

Lab findings for acute pancreatitis

Answer 36

Amylase ⬆️ | Lipase ⬆️

Question 37

Most common cause of chronic pancreatitis

Answer 37

Alcohol abuse

Question 38

Relevant populations in cystic fibrosis? | Gene mutation?

Answer 38

Caucasians Uncommon in Asians and Africans *CFTR gene on 7q

Question 39

Relevant populations in serous cystic neoplasms (cystadenomas) Where are they found?

Answer 39

F 2:1 7th decade Usually in the tail of the pancreas

Question 40

Relevant populations in mucinous cystic neoplasms (cystadenomas)

Answer 40

95% in women Body and tail Slow growing Lined by columnar epithelium

Question 41

1. The majority of pancreatic carcinomas are ___ 2. Risk factors? 3. Most occur where?

Answer 41

1. Adenocarcinomas 2. smoking, drinking, chronic pancreatitis, obesity, diabetes 3. Head

Question 42

Esophageal symptoms worthy of endoscopy

Answer 42

``` Dysphagia Weight loss Chest pain when cardiac problem is ruled out Hematemesis Melena ```

Question 43

Reasons to screen for adenocarcinomas of the esophagus

Answer 43

GERD Smoking Obesity Hiatal hernia

Question 44

No good cancer screening recommendations exist for ___

Answer 44

Esophageal squamous cell carcinoma Gastric adenocarcinomas Pancreatic cancer

Question 45

Screening tests for colorectal cancer

Answer 45

``` fecal occult blood test Fecal immunochemical test Cologuard Flexible sigmoidoscopy Colonoscopy ```

Question 46

Age for screening for colorectal cancer?

Answer 46

Over 50